emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2025.9.1.2382emcardio-113Research ArticleМастер-классMaster-classУспешная одномоментная эмболизация источника лимфореи из грудного протока и баллонная пластика его устья у пациента с циркуляцией фонтенаSuccessful single-stage embolization of the source of lymphorrhea from the thoracic duct and balloonplasty of its ostium in a patient with fontan circulationЧерноглазП. Ф.ChernoglazP. F.

Минск 

Minsk

chernoglaz@gmail.comГУ «Республиканский научно-практический центр детской хирургии»Republican Scientific and Practical Center for Pediatric Surgery2025110920259123822389Copyright © Черноглаз П.Ф., 20252025Черноглаз П.Ф.Chernoglaz P.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/113

Представлен первый случай проведения одномоментной эмболизации источника лимфореи из грудного протока и баллонной пластики его устья для лечения пластического бронхита у пациента с циркуляцией Фонтена в Республике Беларусь и странах СНГ.

Основные осложнения со стороны лимфатической системы у пациентов с циркуляцией Фонтена: пластический бронхит (ПБ), белок теряющая энтеропатия (БТЭП) и хилоторакс (ХТ) обусловливают высокую заболеваемость и смертность в данной группе пациентов, при этом на протяжении многих лет терапевтические опции для таких пациентов остаются ограниченными. Разработанные в последние годы методики: транснодальная лимфангиография, динамическая контрастная магнитно-резонансная лимфангиография, транспеченочная лимфография позволили получить хорошую визуализацию лимфатической системы и выявить основные патофизиологические механизмы, приводящие к нарушению нормальной лимфоциркуляции. Эти механизмы включают в себя 2 фактора: увеличение потока лимфатической жидкости, обусловленное повышением венозного давления, и наличие анатомических особенностей развития лимфатических сосудов, при которых они расположены максимально близко серозному (плевральная полость при хилотораксе) или мукозному (пластический бронхит и белок-теряющая энтеропатия) слоям. Новые минимально инвазивные интервенционные методы, такие как эмболизация грудного протока, интерстициальная эмболизация и эмболизация лимфатических сосудов печени, позволяют блокировать аномальные лимфатические сосуды, что приводит к устранению симптомов. Одномоментная эмболизация источника истечения лимфы и улучшение венозного оттока при выполнении баллонной ангиопластики устья ГЛП потенциально позволяют улучшить непосредственный и долгосрочный результат лечения.

The article presents the first case of simultaneous embolization of the source of lymphorrhea from the thoracic duct and balloon plasty of its ostium for the treatment of plastic bronchitis in a patient with Fontan circulation in the Republic of Belarus.

The main complications of the lymphatic system in patients with Fontan circulation, including plastic bronchitis (PB), protein-losing enteropathy (PLE) and chylothorax (CT), cause high morbidity and mortality in this group of patients, the therapeutic options for such patients have remained limited for many years. The techniques developed in recent years, such as transnodal lymphangiography, dynamic contrast magnetic resonance lymphangiography, transhepatic lymphography, have allowed us to obtain good visualization of the lymphatic system and identify the main pathophysiological mechanisms leading to disruption of normal lymphatic circulation. These mechanisms include 2 factors: an increased flow of lymphatic fluid due to elevated venous pressure and the presence of anatomical features of the development of lymphatic vessels in which they are located extremely close to the serous (pleural cavity in chylothorax) or mucosal (plastic bronchitis and protein-losing enteropathy) layers. New minimally invasive interventional techniques such as thoracic duct embolization, interstitial embolization and embolization of the hepatic lymphatic vessels allow blocking abnormal lymphatic vessels, which leads to the elimination of symptoms. Single-stage embolization of the source of lymph leakage and improvement of venous outflow during balloon angioplasty of the ostium of the thoracic duct (TD) potentially improve the immediate and long-term outcome of treatment.

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The authors declare that there are no conflicts of interest present.